My Testosterone Is Low But My Doc Doesn’t Know

Thanks for the reader feedback from my previous article on low thyroid! Quite a few readers have commented on my unconventional approach to thyroid disease. I have used this approach quite successfully to help our weight loss patients get closer to achieving their goals.

Gals- Lest you think this article is targeted at the guys; read on. The sole female on the winning team of HEAL and The Nest’s Deacon Bob Racicot Open held August 10, 2013 had an advantage. Her testosterone level was NORMAL! Could she hit balls farther, walk faster, and tolerate men better than any other woman on the course? You bet! (She said it was okay to mention this anecdote in conjunction with a plug for two wonderful organizations.)

How do we diagnose low testosterone (low T)? I think an evaluation of symptoms is the best place to start. Signs and symptoms of low T in men and women include fatigue, anxiety, depression, weight gain, memory loss, muscle loss, bone loss- both kinds (think about it), hair loss, elevated cholesterol, insomnia/poor sleep, sleep apnea, and decreased libido to name a few.

What about lab tests? The American College of Obstetricians and Gynecologists doesn’t even recommend checking lab values in perimenopausal women (average ages 40-61 but can occur much earlier). This is where things get weird. They recommend treating perimenopausal women based on their SYMPTOMS! “Ughhh! You mean I have to listen to a patient tell me how they feel?” Yes! In my practice I start with a symptom questionnaire and ask the patients to elaborate when appropriate.

For guys? Men normally have higher testosterone levels than women and I will draw baseline labs before starting testosterone replacement. I frequently see patients who tell me “My primary care doc checked my testosterone and told me it was normal.” Total testosterone IS typically normal in the majority of patients. What does that mean? Testosterone is tightly bound by Sex Hormone Binding Globulin (SHBG). As near as I can figure out, SHBG prevents young men from exploding out of their pants as they enter puberty. After that, I’m not sure what role it plays other than making us miserable…

An analogy I like to use for testosterone is that of an 18-wheel fuel tanker. As you are driving along Sudderth you realize that not only has the NMDOT conspired to make traffic difficult, but there is a fuel tanker on the side of the road that is contributing to the “Texan Trickle” (I can say this because I am, in fact, a Texan). As you crawl to a stop beside the tanker you roll down your window for some trivia and ask the driver how much fuel he can carry. “I’m pulling a full load now with 11,000 gallons of diesel,” he says. You decide to ask why he’s impeding the flow of traffic, to which he replies curtly “I ran out of fuel in this *@!#! stop and go traffic!”

Hmm. A tanker full of diesel but the truck ran out of fuel? Why? There isn’t a connection between the trailer tank and the much smaller fuel tank on the truck. The fuel is tightly bound by the trailer tank. Total fuel looks great. Free fuel, or fuel available to the engine, is GONE.

Is there a test to measure testosterone that isn’t bound to SHBG? It’s called free testosterone! 100% of the patients I have seen that have symptoms of low T have either low or borderline low free T.

Got symptoms of low T? Come talk to me.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He firmly believes that testosterone allows his wife to put up with him (most of the time). Comments or questions? His email address is: